CMS Price Transparency Data
Culture, bacterial
Facility: St Charles Medical Center Prineville
Billing Code: 87070 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 87070
- Insurance Median: $36
- Cash Discount Price: $140
- vs. Medicare Baseline: 4.18x Medicare
The contracted insurance negotiated median rate for a Culture, bacterial at St Charles Medical Center Prineville is $36. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $140. Compared to the federal Medicare reimbursement reference rate of $8.62, this hospital’s rate is 4.18x the Medicare baseline. Located in 384 Se Combs Flat Road, Prineville, OR.
Cash / Self-Pay
$140
Average discount available for prompt cash payment at this facility.
Insurance Median
$36
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$8.62
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $8.62 (100%)
Cash / Self-Pay: $140 (1624%)
Insurance Median: $36 (418%)
Cash: $140 (1624% of Medicare)
Ins. Median: $36 (418% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $8.62 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 418% of the Medicare baseline (a markup of 318%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Input your details and click calculate to compare out-of-pocket costs.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicaid / KanCare | $7 - $23 | 81% |
| Pacificsource Community Solutions [525] | $7 - $8 | 81% |
| Blue Cross Blue Shield | $9 - $31 | 104% |
| Medicare (plans) | $9 - $18 | 104% |
| Otj Dept Of Labor Federal Emp [652] | $11 | 128% |
| Otj Us Department Of Labor [669] | $11 | 128% |
| Kaiser Permanente [334] | $16 - $57 | 186% |
| Moda [310] | $17 - $56 | 197% |
| Providence Health Plan [347] | $17 - $57 | 197% |
| Aetna | $18 - $57 | 209% |
| Ageright Advantage [142] | $18 | 209% |
| Champ Va [700] | $18 | 209% |
| Cigna | $18 - $41 | 209% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $18 | 209% |
| Devoted Health Inc [145] | $18 | 209% |
| Health Market Care Assured [134] | $18 | 209% |
| Health Net Med Adv [135] | $18 | 209% |
| Humana | $18 | 209% |
| Indian Health [704] | $18 | 209% |
| Kaiser Permanente Med Adv [136] | $18 | 209% |
| Law Enforcement [701] | $18 - $32 | 209% |
| Samaritan Health Plan Med Adv [141] | $18 | 209% |
| Unicare [133] | $18 | 209% |
| UnitedHealthcare | $18 - $61 | 209% |
| Veterans [706] | $18 | 209% |
| Wellcare [132] | $18 | 209% |
| Tricare | $20 | 232% |
| Advanced Health [534] | $23 | 267% |
| Allcare Health Plan [538] | $23 | 267% |
| Cascade Health Alliance [532] | $23 | 267% |
| Columbia Pacific Coordinated Care Llc [539] | $23 | 267% |
| Health Share Care Oregon [526] | $23 | 267% |
| Health Share Kaiser [543] | $23 | 267% |
| Health Share Ohsu Ohp [552] | $23 | 267% |
| Health Share Providence [548] | $23 | 267% |
| Health Share [537] | $23 | 267% |
| Intercommunity Health [530] | $23 | 267% |
| Jackson Care Connect [542] | $23 | 267% |
| Primary Health Of Jospehine County Llc [547] | $23 | 267% |
| Umpqua Health [533] | $23 | 267% |
| Willamette Valley Community Health [536] | $23 | 267% |
| Yamhill County Coordinated Care Org [550] | $23 | 267% |
| Bridgespan [342] | $26 | 302% |
| Pacificsource [345] | $26 - $36 | 302% |
| Asuris Northwest Health [202] | $31 | 360% |
| Healthcare Management Admin [201] | $31 | 360% |
| Regence Group Administrators [203] | $31 | 360% |
| Us Benefits [326] | $41 | 476% |
| Rocky Mountain Administrators [405] | $52 | 603% |
| Rx Internal [4100003] | $54 | 626% |
| First Choice Health [317] | $57 | 661% |
| Meritain Health [300] | $57 | 661% |
| Samaritan [376] | $57 | 661% |
| Health Net [340] | $62 | 719% |
| Administrative Concepts Inc [402] | $64 | 742% |
| First Health [339] | $64 | 742% |
| Manhattan Life Insurance Company [379] | $64 | 742% |
| Philadelphia American Life Insurance Company [395] | $64 | 742% |
| Planned Administrators Inc [375] | $64 | 742% |
| Auto Allstate Insurance [602] | $65 | 754% |
| Auto American Family Insurance [603] | $65 | 754% |
| Auto Country Insurance Claims [604] | $65 | 754% |
| Auto Dairyland Insurance [617] | $65 | 754% |
| Auto Farmers [605] | $65 | 754% |
| Auto Geico Claims Oregon [606] | $65 | 754% |
| Auto Hartford [612] | $65 | 754% |
| Auto Liberty Mutual Auto Ins [613] | $65 | 754% |
| Auto Mutual Of Enumclaw [610] | $65 | 754% |
| Auto Nationwide Allied Insuranc [601] | $65 | 754% |
| Auto Oregon Mutual [614] | $65 | 754% |
| Auto Progressive [608] | $65 | 754% |
| Auto Safeco Concentra [600] | $65 | 754% |
| Auto State Farm Claims [609] | $65 | 754% |
| Auto Sublimity Insurance [616] | $65 | 754% |
| Auto Travelers Insurance [615] | $65 | 754% |
| Auto Usaa [611] | $65 | 754% |
| Generic Auto [649] | $65 | 754% |
| Generic Workers Comp [699] | $65 | 754% |
| Otj Broadspire Services [670] | $65 | 754% |
| Otj Ccmsi [618] | $65 | 754% |
| Otj Chartis Claims [650] | $65 | 754% |
| Otj City County Ins Services [662] | $65 | 754% |
| Otj Corvel [676] | $65 | 754% |
| Otj Esis West Wc Claims [653] | $65 | 754% |
| Otj Gallagher Bassett [654] | $65 | 754% |
| Otj Hartford [655] | $65 | 754% |
| Otj Intermountain Claims Inc [666] | $65 | 754% |
| Otj Liberty Mutual Wausau Underwriters [671] | $65 | 754% |
| Otj Penser No American [663] | $65 | 754% |
| Otj Pinnacle Risk Mgmt [661] | $65 | 754% |
| Otj Saif [667] | $65 | 754% |
| Otj Sedgwick Cms [660] | $65 | 754% |
| Otj Sedgwick [668] | $65 | 754% |
| Otj Travelers Insurance [672] | $65 | 754% |
| Otj Tristar [673] | $65 | 754% |